CONTENTS 2024_4
HYGIENE
Meltser A.V.,Erastova N.V., Volochkova A.I.
Koroleva A.A., Yanushanets O.I.
Kucherskaya T.I., Alikbaeva L.A., Yakubova I.Sh., Ryzhkov A.L., Moschev A.N., Fomin M.V., Smirnova M.E.
DIAGNOSIS, TREATMENT, EPIDEMIOLOGY, PREVENTION OF DISEASES
Arseniev A.I., Novikov S.N., Gagua K.E., Nefedov A.O., Arseniev E.A., Tarkov S.A., Novikov R.V.,Zozulya A.Yu., Antipov F.E., Barchuk A.A.
Kobzeva Yu.V., Andreeva E.E., Zadorozhny A.V., Pshenichnaya N.Yu., Ugleva S.V., Lizinfeld I. A., Ivanov S.S.
Kholopov D.V., Lyalina L.V., Khizha V.V., Topuzov E.E.
Peleshok S.A., Tsygan L.S., Kolbin A.A., Virko V.A., Klishin I.V., Vlasovets A.A., Prokofev M.S., Sukhorukov A.A.
Dmitrieva O.V., Liubimova A.V., Belova L.V.
PUBLIC HEALTH, ORGANIZATION AND SOCIOLOGY OF HEALTH CARE
Tyumina O.V., Degeleva O.M., Khashina O.A.
Khodakova O.V., Bogdanova T.G., Shakhova A.M.
CLINICAL LABORATORY DIAGNOSTICS
Mikryukova N.V., Bychkova N.V., Kalinina N.M.
Yershova I.B., Petrenko O.V.
HYGIENE
HYGIENIC ASPECTS OF PRESERVING AND STRENGTHENING THE HEALTH OF EMPLOYEES IN CORPORATE PROGRAMS
(SCIENTIFIC REVIEW)
A.V. Meltser, N.V. Erastova, A.I. Volochkova
North-West State Medical University named after I.I. Mechnikov,Russia, 191015, Saint-Petersburg, Petersburg, Kirochnaya street, 41
Abstract
Caring for the health of the working population occupies a special place among the priority areas of state policy and is dictated by the strategic interests of the state. Achieving the goals of national projects requires the development and implementation of a comprehensive set of measures. In this regard ,the Russian Federation has established a system for preserving and strengthening the health of workers, one of the tools of which is corporate programs. The experience of implementing corporate programs demonstrate their effectiveness. At the same time, there are several areas that require improvement and development.
Keywords: health of workers, protection and strengthening of health of workers, professional stress, working conditions, health in the workplace, corporate health programs, professional risk, occupational hygiene, prevention of stress in workers.
DEFINING THE CHARACTERISTICS OF EDUCATIONAL CONTENT TO SUBSTANTIATE HYGIENIC ASSESSMENT CRITERIA, TAKING INTO ACCOUNT THE TYPES OF EDUCATIONAL ACTIVITIES OF HIGH SCHOOL STUDENTS
A.A. Koroleva, O.I. Yanushanets
North-Western State Medical University named after I.I. Mechnikov. Russia, 191015, Saint Petersburg, Kirochnaya Street, 41
Abstract
Introduction. In the modern educational space, special attention is paid to the quality of educational content presented on electronic learning tools, which plays an important role in the formation of knowledge and skills of high school students. This article identifies the characteristics of digital educational content that cause irritation, nervous and emotional tension and fatigue of the visual analyzer in high school students, taking into account the types of educational activities for further substantiation of hygiene assessment criteria.
The aim of the study is to determine criteria for hygienic assessment of educational content, taking into account the type of educational activity of high school students.
Materials and methods. To identify specific parameters of educational content used in various types of educational activities (theory, exercises, assessment), a survey was conducted among high school students (grades 10-11), allowing us to identify parameters characterizing the usability of the educational content interface for each type of activity. The study involved 342 participants
Results. The study allowed to determine the key characteristics of the hygienic assessment of educational content in various types of educational activities: font design (size, text density); color design (color scheme, background color); illustrative design (position on the page, resolution quality, ability to open an object on a separate page); animation design (constant movement of objects, types of animation effects); time limitations on using educational content;; audio and video accompaniment; advertising.
Conclusion. Using a survey of high school students, the main characteristics of modern educational content that cause irritation, nervous and emotional tension and fatigue of the visual analyzer at work were determined. Taking into account the identified characteristics of educational content will provide the opportunity to conduct research aimed at physiological and hygienic assessment and substantiation of criteria for evaluating electronic educational materials.
Keywords: high school students, educational content, type of educational activity, visual discomfort, interface, multimedia, interactivity.
CHARACTERISTICS OF MERCURY POLLUTION TERRITORIES AS OBJECTS OF ACCUMULATED HARM TO THE ENVIRONMENT
(SCIENTIFIC REVIEW)
T.I. Kucherskaya2, L.A. Alikbaeva1, I.Sh. Yakubova1, A.L. Ryzhkov1,
A.N. Moschev1, M.V. Fomin1, M.E. Smirnova1
1North-West State Medical University named after I.I. Mechnikov, Russia, 191015, Saint Petersburg, Kirochnaya street,41
2Research Institute of Hygiene, Occupational Pathology and Human Ecology, Russia, 188663, Leningrad Region, Vsevolozhsk microdistrict, Kuzmolovskoye urban settlement, Zavodskaya street, 6/2, bldg. 93,
Abstract
According to the state register of objects of accumulated environmental damage (ECD) in Russia as of 14.06.2023, 699 objects have been identified. ECD objects contaminated with mercury are one of the main sources of mercury exposure for humans. The register of ECD objects as territories of accumulated mercury pollution includes 4 objects: the industrial site of Usolye-Khimprom LLC in Usolye-Sibirskoye, Irkutsk Region; the Beloye More sludge pond in the Kirovsky District of Volgograd; the territory of the Aktash Mining and Metallurgical Enterprise in the village of Aktash, Altai Republic; the territory of the former Semenovskaya gold extraction plant, located south of the city of Baimak, Republic of Bashkortostan.
The scientific review presents literature data on mercury pollution of atmospheric air, water sources and soil in four territories of accumulated mercury pollution in Russia.
The solution to the problem of stopping the impact of accumulated mercury pollution of NVOOS objects on public health is not associated with the cessation of the activities of these enterprises as sources of environmental pollution, but with the elimination of the consequences of its pollution from the former activities of the objects.
Key words: mercury, areas of accumulated mercury pollution, objects of accumulated harm to the environment, environment, atmospheric air, water sources, soil.
DIAGNOSIS, TREATMENT, EPIDEMIOLOGY, PREVENTION OF DISEASES
Individualized (adaptive and isotoxic) radiotherapy for locally advanced non-small cell lung cancer (REVIEW)
A.I. Arseniev1,2, S.N. Novikov1, K.E. Gagua2, A.O. Nefedov3, E.A. Arseniev1, S.A. Tarkov1, R.V. Novikov1, A.Yu. Zozulya1, F.E. Antipov1, A.A. Barchuk1
1N.N. Petrov National Medical Research Center of Oncology. Russia, 197758, Saint Petersburg, Pesochny, Leningradskaya str, 68
2 North-Western State Medical University named after I.I. Mechnikov. Russia, 191015, Saint-Petersburg, Kirochnaya street, 41
3 Saint-Petersburg State Research Institute of Phthisiopulmonology. Russia, 191036, Saint Petersburg, Ligovsky av., д.2-4
Abstract
Lung cancer in 2022 became a common malignant neoplasm and the main cause of cancer-related death, with non-small cell lung cancer (NSCLC), accounting for 80% of cases. This scientific review analyzes literature data related to current issues in oncology and radiotherapy, determining the role of individualized (adaptive and isotoxic) approaches in the radiation treatment of locally advanced non-small cell lung cancer, as well as evaluating their potential, safety, and effectiveness. Modern standards for the primary treatment methods for such patients involve a combination of systemic and radiation therapy. Personalizing treatment based on a comprehensive assessment of the extent of disease spread and the characteristics of the tumor process, along with the functional status of patients, represents a promising direction in oncology.
The most relevant studies on adaptive radiotherapy focus on analyzing the informativeness of various imaging options, each of which has its disadvantages and advantages related to image quality, additional time costs, increased expenses, and radiation exposure for patients and staff. Active efforts continue to create an effective model for monitoring and screening patients during radiation therapy to identify those who require plan adjustments. Replanning during treatment allows you to increase the dose per target and reduce the likelihood of complications in normal tissues. Anatomical and positional changes affect the doses received by organs at risk, and their repeated monitoring allows for an accurate assessment of the actual values and predicting toxicity. Adaptive radiation therapy is one of the most promising approaches to improve the immediate and long-term outcomes of lung cancer treatment. This method leads to favorable dosimetric changes, especially in patients with a large initial irradiated volume receiving concurrent chemoradiotherapy. However, criteria for clinically significant tumor reduction have not yet been fully determined, leaving unresolved issues regarding the timeliness of decisions on plan adjustments.
Key words: review; non-small cell lung cancer; isotoxic radiation therapy, adaptive radiation therapy, individualized radiotherapy.
RESULTS OF MICROBIOLOGICAL MONITORING OF ENVIRONMENTAL OBJECTS IN INTENSIVE CARE UNITS IN PATIENTS WITH COVID-19 IN MOSCOW HOSPITALS
Yu. V. Kobzeva1, E. E. Andreeva1, A. V. Zadorozhny1, N. Yu. Pshenichnaya2, S. V. Ugleva2, I. A. Lizinfeld2, S. S. Ivanov3
1Office of the Federal Service for Supervision of Consumer Rights Protection and Human Wellbeing in the City of Moscow, Russia, 129626, Moscow, Grafsky lane, 4/9
2Central Research Institute of Epidemiology, Russia, 111123, Moscow, Novogireevskaya street, 3a
3I. M. Sechenov First Moscow State Medical University, Russia, 119435, Moscow, Bolshaya Pirogovskaya street, 2, building 4
Abstract
Introduction. Nosocomial infections are an urgent problem for the healthcare system, which necessitates regular microbiological monitoring in hospitals.
Aim of the study was to conduct microbiological monitoring of microorganisms in intensive care units for patients with new coronavirus infection.
Materials and methods. A total of 2,240 swabs were collected from environmental objects in intensive care units across 35 hospitals in Moscow.
Results. The circulation of microorganisms was established in 13 hospitals in Moscow (37.1%). The dominant microorganisms were coagulase-negative staphylococci. The largest number of positive flushes were obtained from artificial lung ventilation systems. The proportion of microorganisms with multidrug resistance was noted at 12.2%.
Conclusion. The epidemiological situation in the intensive care units of Moscow hospitals requires increased control over the epidemiological regime.
Keywords: intensive care units, microbiological monitoring, microorganisms, new coronavirus infection, flushes from facilities, staphylococci.
USE OF THREE-DIMENSIONAL PRINTING TECHNOLOGIES
IN THE COMPLEX TREATMENT OF MIDDLE FACE INJURIES
S.A. Peleshok, L.S. Tsygan, A.A. Kolbin, V.A. Virko, I.V. Klishin,
A.A. Vlasovets, M.S. Prokofev, A.A. Sukhorukov
S. M. Kirov Military Medical Academy, St. Petersburg, Russia, Academician Lebedev street 6
Abstract
Introduction. Three-dimensional printing (3D printing) and reconstructive surgery are two fields that, when combined, open up new treatment possibilities for conditions previously limited to traditional treatment methods. Reconstructive surgery, both elective and emergency, actively utilizes new 3D modeling and printing technology to minimize patient preparation time for surgery, improve the cosmetic outcome of interventions, and reduce the number of postoperative complications. The modern capabilities of 3D printing are expanding, with increasing quality and variety of software, 3D printers, and materials, biocompatible materials are being synthesized, suitable for use in 3D printing and subsequent implantation in order to replace the defect.
The aim of the study is to demonstrate the experience of using 3D modeling and printing techniques for preoperative planning and conducting elective and emergency reconstructive operations for middle face injuries.
Materials and methods. A search and analysis of domestic and foreign publications from 2016 to 2024 was performed. Based on the presented results of non-invasive (tomographic) studies of patients in DICOM format, a set of equipment was used, including a graphics station (a stationary personal computer with an Intel Core I7-6700 processor, an NVIDIA GeForce GTX 1060 6GB GPU and a 32 GB RAM block), software (COMPASS 3D, SolidWorks, CURA, Polygon X) and 3D printers (Ender 3 Pro and Picaso Designer X Pro S2) printing by modeling layered plastic deposition of polylactide and acrylonitrile butadiene styrene, 1.75 mm in cross-section diameter.
Results. The article presents clinical cases reflecting the experience of surgeons from the Military Medical Academy and specialists of the research Center in using three-dimensional modeling and 3D printing technologies for preoperative models in conjunction with surgical procedures for various complex pathologies of middle face injuries during 2023-2024.
Conclusion. The high efficiency of applying three-dimensional modeling and 3D printing technologies as an auxiliary element in the classical management of surgical patients during preoperative planning and surgical intervention has been confirmed.
Keywords: three-dimensional modeling; three-dimensional printing; surgery; clinical case; implant; biocompatibility; preoperative planning.
INFECTIOUS COMPLICATIONS IN PATIENTS RECEIVING HEMODIALYSIS
O.V. Dmitrieva, A.V. Liubimova, L.V. Belova
North-Western State Medical University named after I.I. Mechnikov, Russia, 191015, Saint Petersburg, Kirochnaya street, 41
Abstract
Introduction. Infectious complications in patients receiving renal replacement therapy pose a significant threat to their health and life. Invasive interventions, kidney disease and comorbidities, frequent hospitalisation contribute to the development of infections, including healthcare-associated infection.
The aim of the study is to identify the frequency, structure and etiology of infectious complications in patients receiving hemodialysis, both upon admission to departments of various profiles and during hospitalization.
Materials and Methods. Medical records of 855 patients receiving haemodialysis in 2020-2023, hospitalized in different departments of multidisciplinary clinics, were analyzed.
Results. A high frequency of hospitalizations for hemodialysis patients in various departments was identified. A total of 214 infections (25.02 per 100 patients, 25.32 per 100 hospitalizations) were detected in 104 patients: bloodstream infections -87 cases (10.17 per 100 patients), respiratory tract infections-45 cases (5.26 per 100 patients), urinary tract infections -33 cases (3.86 per 100 patients), surgical site infections-24 cases (1.58 per 100 patients), skin and soft tissue infections -16 cases (1.87 per 100 patients), infective endocarditis-8 cases (0.94 per 100 patients). More than one infection occurred in 62 (59.61%) patients, 65% of the infections occurred more than 48 hours after admission to the department. The etiology was identified in 72% of infections detected at admission and in 60% of healthcare-associated infections (HAIs). The etiological structure of the infections was diverse; however, Staphylococcus aureus was the most frequently isolated microorganism.
Conclusion. A high risk of infectious complications in hemodialysis patients has been revealed both at admission to various departments and during treatment. It is necessary to develop and implement epidemiological surveillance programs and microbiological monitoring of hemodialysis patients hospitalized in non-dialysis units.
Keywords: hemodialysis, renal replacement therapy, infectious complications, hospitalization, healthcare-associated infections.
PUBLIC HEALTH, ORGANIZATION AND SOCIOLOGY OF HEALTH CARE
THE ROLE OF INFECTIOUS FACTOR IN EARLY TERMINATION OF PREGNANCY: IMPORTANCE FOR ORGANIZING CARE FOR PREGNANT WOMEN
O.V. Tyumina1,2, O.M. Degeleva1,2, O.A. Khashina2
1Samara Regional Medical Center «Dynasty», Russia, 443095, Samara, Tashkentskaya street, 159
2Samara State Medical University, Russia, 443099, Samara, Chapaevskaya street, 89
Abstract
Introduction. Spontaneous abortion is one of the main types of obstetric pathology, with a frequency of 15-20% of all desired pregnancies. The causes of spontaneous abortions in in the early stages of pregnancy are extremely diverse and not always clearly defined.
Aim of the study was to analyze the impact of infectious factors on pregnancy outcomes in early and late stages and to develop a set of organizational measures for prevention and timely treatment to improve perinatal indicators.
Materials and methods. Microbiological examination of urine and cervical canal discharge was conducted in 215 women, average age 31±2.1 years, who were at risk of pregnancy termination at a gestational age of 15±3.0 weeks. The participants were divided into two groups: Group 1 (190 individuals) - pregnancy was saved, Group 2 (25 individuals) - pregnancy was terminated. Laboratory, sociological and statistical research methods were used.
Results. The analysis showed that positive bacteriological results from urine and cervical canal discharge do not have a statistically significant effect on the abortion outcomes in early stages of pregnancy. However, these data should be considered as a risk factor for pregnancy loss and preterm birth at later stages. The leading pathogens were E. coli and Enterococcus faecalis.
Conclusion. In order to reduce the incidence of infectious complications and improve perinatal outcomes, the authors propose a set of measures, including increasing awareness among the population and health workers, improving screening and diagnostic system, optimizing treatment and preventive measures, developing interdisciplinary interaction between specialists and research activities.
Key words: spontaneous abortion, bacteriuria, risk factors for pregnancy loss
ORGANIZATIONAL MODELS OF OUTPATIENT ADMISSION OF A DISTRICT GENERAL PRACTITIONER
O.V. Khodakova, T.G. Bogdanova, A.M. Shakhova
Russian Research Institute of Health, Russia, 127254, Moscow, Dobrolyubova street, 11
Abstract
Introduction. Ensuring accessibility in the primary healthcare system, as the basis of the health care system, remains relevant. The most demanded specialist for providing medical care to the adult population at the outpatient stage remains a district therapist. In the system of public healthcare system in the Russian Federation, there are organizational solutions aimed at freeing up the time of district therapists from a number of routine procedures and documentation processes to increase the time of direct contact with patients. Such solutions contribute to the rational use of human resources of medical organizations, allowing to increase the accessibility and quality of primary healthcare services without additional costs. A comparative analysis of throughput per hour and per working shift in organizing outpatient appointments for district therapists using such solutions has not been conducted.
The aim of the study is to develop organizational models for the work of a district general practitioner and a district nurses, that optimize patient interaction time and increase the throughput of outpatient appointments for district therapists.
Materials and methods. The study of the issues of providing primary health care to the adult population during outpatient appointment with district therapists was conducted based on content analysis including a review of normative-legal documents and the results of scientific research by domestic authors.
The study used materials from scientific electronic libraries eLibrary, «CyberLeninka», reference legal system «Consultant Plus», «Garant», the website of the Ministry of Health of Russia and publicly accessible internet resources, that met the inclusion criteria for analysis (compliance with the selected research topic, full-text format of the work, open (free) access). The search was conducted using the following keywords: primary health care, independent reception, delegation of functions, medical post, non-medical staff, throughput.
Based on the method of organizational modeling, solutions for the organization of outpatient reception of a district general practitioner have been developed: the minimum number of participants in the process to perform one cycle of work has been consistently determined; a calculation of the baseline time necessary for the reception of one patient by all participants in the process has been conducted; the list of functional duties for each employee has been assessed by the coefficient of labor intensity of functional duties. When the number of performed tasks changes, the coefficient of labor intensity of functional duties changes, affecting the time spent on the receiving one patient. To determine the effectiveness of a particular organizational model in terms of throughput, the normative throughput of outpatient appointments was calculated.
Results. Organizational models for outpatient reception by a district general practitioner were formed, based on structured decisions on redistribution of functions between separate categories of medical and non-medical personnel, as well as on formation of patient flows according to the purpose of their treatment. The throughput capacity of each of the models was determined, taking into account the labor intensity of functional duties and time spent on the receiving one patient. A comparative analysis of the throughput per hour and per working shift of the proposed organizational solutions for outpatient reception by a district general practitioner has been carried out.
Conclusion. The throughput capacity of the proposed organizational models of outpatient admission of a district general practitioner varies depending on the number of participants in the process and the labor functions assigned to them. Thus, the introduction of an independent reception of a nurse with a higher education in nursing (bachelor's degree) or a paramedic into the «classical model» of outpatient reception of a district general practitioner increases the throughput capacity of the model almost three times. The organization of a medical post with the withdrawal of district nurses from the joint reception with district physicians increases the throughput capacity by more than 35%, compared to the simultaneous work of the same number of specialists according to the principles of the «classical mode». The organization of independent reception of nurses with higher education in «Nursing» (bachelor's degree) or paramedics in parallel with outpatient reception of district therapists increases the throughput capacity of outpatient reception three times, compared to the simultaneous work of the same number of specialists within the «classical model».
Keywords: primary health care, independent reception, delegation of functions, medical post, non-medical staff, throughput capacity.
CLINICAL LABORATORY DIAGNOSTICS
PROBLEMS IN THE DIAGNOSIS OF FOOD INTOLERANCE, QUESTIONABLE SIGNIFICANCE OF DIAMINE OXIDASE, POSSIBILITY OF HISTAMINE INACTIVATION COEFFICIENT IN PATIENTS WITH CHRONIC URTICARIA
N.V. Mikryukova1, N.V. Bychkova1, N.M. Kalinina1,2
1Nikiforov Russian Center of Emergency and Radiation Medicine, EMERCOM of Russia, St. Petersburg, Russia
2St. Petersburg Pavlov State Medical University, Ministry of health of Russia
Abstract
Most food reactions require careful assessment and confirmation, as dietary restrictions could lead to negative consequences and a decline in quality of life. This article presents a review of the latest data on food intolerance and the results of the present research concerning the determination of histamine, diamine oxidase (DAO), and the histamine inactivation ratio in patients with chronic urticaria (CU).
The study included 165 adults aged 18 to 68 years; 97 patients suffering from chronic urticaria, while the comparison group consisted of 68 healthy individuals. The levels of histamine and diamine oxidase in the blood serum were assessed using the enzyme-linked immunosorbent assay (ELISA). The histamine inactivation coefficient was calculated as the ratio of histamine to diamine oxidase.
There was an increase in histamine concentration and histamine inactivation coefficient in patients with CU in relation to the comparison group - 23.92ng/ml and 10.93 ng/ml; 1.74 and 0.82, respectively. Patients with CU and food intolerance had a history of increased histamine concentration and histamine inactivation coefficient in relation to the group of patients without food intolerance and conditionally healthy individuals. Patients with concomitant digestive system pathology showed increased levels of diamine oxidase, which corresponds to diamine oxidase as a marker of mucosal integrity.
The study indicated the questionable significance in measuring diamine oxidase as an independent diagnostic parameter; however, it was found that the histamine inactivation ratio may serve as a new biomarker of food intolerance in patients with CU.
Key words: histamine, diamine oxidase, histamine inactivation coefficient, chronic urticaria.
CLINICAL AND IMMUNOLOGICAL INDICATORS OF THE HEALTH STATUS OF CHILDREN WITH GIARDIASIS
I.B. Ershova, O.V. Petrenko
Federal State Budgetary Educational Institution of Higher Education "Lugansk State Medical University named after St. Luke" of the Ministry of Health of the Russian Federation, 291045, Russian Federation, Lugansk People's Republic, urban district Lugansk, city of Lugansk, kv-l 50-letiya oborony Luganska, d. 1g
Abstract.
Introduction. Infection with giardiasis in children's groups reaches 50-80%. Despite the abundance of publications, the issue of differences in the course of giardiasis in children of different ages and the immune system`s response to Giardia invasion remains poorly studied.
The aim of the study is to analyze the clinical and immunological characteristics of children infected with Giardia, focusing on age-related differences.
Materials and methods. Children with giardiasis of two age subgroups were observed - I (median age 4.2 years) - 71 participants and II (median age 15.9 years) - 63 participants. The control group (n = 63) included children of the same age and sex. A set of indicators characterizing cellular and humoral immunity was studied.
Results and discussion. For children aged 1 to 12 years, the acute course of giardiasis is characterized by clinical manifestations such as decreased appetite, flatulence and intestinal rumbling, loose stools, headache, abdominal pain, allergic skin rashes, asthenonerotic symptoms. Children aged 13 to 18 years predominantly experienced a chronic course of giardiasis, with symptoms including abdominal pain of various localizations, decreased appetite, bloating and rumbling, frequent liquid foul-smelling stools, nausea, belching, increased fatigue, emotional lability, subfebrile condition, decreased mood, pale skin, tearfulness, depressed mood, vegetative manifestations, broncho-asthmatic manifestations. Immunological assessments reveal a decrease in
CD4 + and an increase in CD8 +, and a decrease in the immunoregulatory index. A decrease in CD4+ and an increase in CD8+ were noted. The IgA level was below the control values.
Conclusions. In response to Giardia invasion, children experience changes in both cellular and humoral immunity, indicating varying degrees of impairment in immunological reactivity and have unidirectional changes in children of primary, preschool-school and adolescent age.
Key words: giardiasis, children, immunity, giardia, parasitosis.
CONTENTS 2024_4
HYGIENE
Meltser A.V.,Erastova N.V., Volochkova A.I.
Koroleva A.A., Yanushanets O.I.
Kucherskaya T.I., Alikbaeva L.A., Yakubova I.Sh., Ryzhkov A.L., Moschev A.N., Fomin M.V., Smirnova M.E.
DIAGNOSIS, TREATMENT, EPIDEMIOLOGY, PREVENTION OF DISEASES
Arseniev A.I., Novikov S.N., Gagua K.E., Nefedov A.O., Arseniev E.A., Tarkov S.A., Novikov R.V.,Zozulya A.Yu., Antipov F.E., Barchuk A.A.
Kobzeva Yu.V., Andreeva E.E., Zadorozhny A.V., Pshenichnaya N.Yu., Ugleva S.V., Lizinfeld I. A., Ivanov S.S.
Kholopov D.V., Lyalina L.V., Khizha V.V., Topuzov E.E.
Peleshok S.A., Tsygan L.S., Kolbin A.A., Virko V.A., Klishin I.V., Vlasovets A.A., Prokofev M.S., Sukhorukov A.A.
Dmitrieva O.V., Liubimova A.V., Belova L.V.
PUBLIC HEALTH, ORGANIZATION AND SOCIOLOGY OF HEALTH CARE
Tyumina O.V., Degeleva O.M., Khashina O.A.
Khodakova O.V., Bogdanova T.G., Shakhova A.M.
CLINICAL LABORATORY DIAGNOSTICS
Mikryukova N.V., Bychkova N.V., Kalinina N.M.
Yershova I.B., Petrenko O.V.
HYGIENE
HYGIENIC ASPECTS OF PRESERVING AND STRENGTHENING THE HEALTH OF EMPLOYEES IN CORPORATE PROGRAMS
(SCIENTIFIC REVIEW)
A.V. Meltser, N.V. Erastova, A.I. Volochkova
North-West State Medical University named after I.I. Mechnikov,Russia, 191015, Saint-Petersburg, Petersburg, Kirochnaya street, 41
Abstract
Caring for the health of the working population occupies a special place among the priority areas of state policy and is dictated by the strategic interests of the state. Achieving the goals of national projects requires the development and implementation of a comprehensive set of measures. In this regard ,the Russian Federation has established a system for preserving and strengthening the health of workers, one of the tools of which is corporate programs. The experience of implementing corporate programs demonstrate their effectiveness. At the same time, there are several areas that require improvement and development.
Keywords: health of workers, protection and strengthening of health of workers, professional stress, working conditions, health in the workplace, corporate health programs, professional risk, occupational hygiene, prevention of stress in workers.
DEFINING THE CHARACTERISTICS OF EDUCATIONAL CONTENT TO SUBSTANTIATE HYGIENIC ASSESSMENT CRITERIA, TAKING INTO ACCOUNT THE TYPES OF EDUCATIONAL ACTIVITIES OF HIGH SCHOOL STUDENTS
A.A. Koroleva, O.I. Yanushanets
North-Western State Medical University named after I.I. Mechnikov. Russia, 191015, Saint Petersburg, Kirochnaya Street, 41
Abstract
Introduction. In the modern educational space, special attention is paid to the quality of educational content presented on electronic learning tools, which plays an important role in the formation of knowledge and skills of high school students. This article identifies the characteristics of digital educational content that cause irritation, nervous and emotional tension and fatigue of the visual analyzer in high school students, taking into account the types of educational activities for further substantiation of hygiene assessment criteria.
The aim of the study is to determine criteria for hygienic assessment of educational content, taking into account the type of educational activity of high school students.
Materials and methods. To identify specific parameters of educational content used in various types of educational activities (theory, exercises, assessment), a survey was conducted among high school students (grades 10-11), allowing us to identify parameters characterizing the usability of the educational content interface for each type of activity. The study involved 342 participants
Results. The study allowed to determine the key characteristics of the hygienic assessment of educational content in various types of educational activities: font design (size, text density); color design (color scheme, background color); illustrative design (position on the page, resolution quality, ability to open an object on a separate page); animation design (constant movement of objects, types of animation effects); time limitations on using educational content;; audio and video accompaniment; advertising.
Conclusion. Using a survey of high school students, the main characteristics of modern educational content that cause irritation, nervous and emotional tension and fatigue of the visual analyzer at work were determined. Taking into account the identified characteristics of educational content will provide the opportunity to conduct research aimed at physiological and hygienic assessment and substantiation of criteria for evaluating electronic educational materials.
Keywords: high school students, educational content, type of educational activity, visual discomfort, interface, multimedia, interactivity.
CHARACTERISTICS OF MERCURY POLLUTION TERRITORIES AS OBJECTS OF ACCUMULATED HARM TO THE ENVIRONMENT
(SCIENTIFIC REVIEW)
T.I. Kucherskaya2, L.A. Alikbaeva1, I.Sh. Yakubova1, A.L. Ryzhkov1,
A.N. Moschev1, M.V. Fomin1, M.E. Smirnova1
1North-West State Medical University named after I.I. Mechnikov, Russia, 191015, Saint Petersburg, Kirochnaya street,41
2Research Institute of Hygiene, Occupational Pathology and Human Ecology, Russia, 188663, Leningrad Region, Vsevolozhsk microdistrict, Kuzmolovskoye urban settlement, Zavodskaya street, 6/2, bldg. 93,
Abstract
According to the state register of objects of accumulated environmental damage (ECD) in Russia as of 14.06.2023, 699 objects have been identified. ECD objects contaminated with mercury are one of the main sources of mercury exposure for humans. The register of ECD objects as territories of accumulated mercury pollution includes 4 objects: the industrial site of Usolye-Khimprom LLC in Usolye-Sibirskoye, Irkutsk Region; the Beloye More sludge pond in the Kirovsky District of Volgograd; the territory of the Aktash Mining and Metallurgical Enterprise in the village of Aktash, Altai Republic; the territory of the former Semenovskaya gold extraction plant, located south of the city of Baimak, Republic of Bashkortostan.
The scientific review presents literature data on mercury pollution of atmospheric air, water sources and soil in four territories of accumulated mercury pollution in Russia.
The solution to the problem of stopping the impact of accumulated mercury pollution of NVOOS objects on public health is not associated with the cessation of the activities of these enterprises as sources of environmental pollution, but with the elimination of the consequences of its pollution from the former activities of the objects.
Key words: mercury, areas of accumulated mercury pollution, objects of accumulated harm to the environment, environment, atmospheric air, water sources, soil.
DIAGNOSIS, TREATMENT, EPIDEMIOLOGY, PREVENTION OF DISEASES
Individualized (adaptive and isotoxic) radiotherapy for locally advanced non-small cell lung cancer (REVIEW)
A.I. Arseniev1,2, S.N. Novikov1, K.E. Gagua2, A.O. Nefedov3, E.A. Arseniev1, S.A. Tarkov1, R.V. Novikov1, A.Yu. Zozulya1, F.E. Antipov1, A.A. Barchuk1
1N.N. Petrov National Medical Research Center of Oncology. Russia, 197758, Saint Petersburg, Pesochny, Leningradskaya str, 68
2 North-Western State Medical University named after I.I. Mechnikov. Russia, 191015, Saint-Petersburg, Kirochnaya street, 41
3 Saint-Petersburg State Research Institute of Phthisiopulmonology. Russia, 191036, Saint Petersburg, Ligovsky av., д.2-4
Abstract
Lung cancer in 2022 became a common malignant neoplasm and the main cause of cancer-related death, with non-small cell lung cancer (NSCLC), accounting for 80% of cases. This scientific review analyzes literature data related to current issues in oncology and radiotherapy, determining the role of individualized (adaptive and isotoxic) approaches in the radiation treatment of locally advanced non-small cell lung cancer, as well as evaluating their potential, safety, and effectiveness. Modern standards for the primary treatment methods for such patients involve a combination of systemic and radiation therapy. Personalizing treatment based on a comprehensive assessment of the extent of disease spread and the characteristics of the tumor process, along with the functional status of patients, represents a promising direction in oncology.
The most relevant studies on adaptive radiotherapy focus on analyzing the informativeness of various imaging options, each of which has its disadvantages and advantages related to image quality, additional time costs, increased expenses, and radiation exposure for patients and staff. Active efforts continue to create an effective model for monitoring and screening patients during radiation therapy to identify those who require plan adjustments. Replanning during treatment allows you to increase the dose per target and reduce the likelihood of complications in normal tissues. Anatomical and positional changes affect the doses received by organs at risk, and their repeated monitoring allows for an accurate assessment of the actual values and predicting toxicity. Adaptive radiation therapy is one of the most promising approaches to improve the immediate and long-term outcomes of lung cancer treatment. This method leads to favorable dosimetric changes, especially in patients with a large initial irradiated volume receiving concurrent chemoradiotherapy. However, criteria for clinically significant tumor reduction have not yet been fully determined, leaving unresolved issues regarding the timeliness of decisions on plan adjustments.
Key words: review; non-small cell lung cancer; isotoxic radiation therapy, adaptive radiation therapy, individualized radiotherapy.
RESULTS OF MICROBIOLOGICAL MONITORING OF ENVIRONMENTAL OBJECTS IN INTENSIVE CARE UNITS IN PATIENTS WITH COVID-19 IN MOSCOW HOSPITALS
Yu. V. Kobzeva1, E. E. Andreeva1, A. V. Zadorozhny1, N. Yu. Pshenichnaya2, S. V. Ugleva2, I. A. Lizinfeld2, S. S. Ivanov3
1Office of the Federal Service for Supervision of Consumer Rights Protection and Human Wellbeing in the City of Moscow, Russia, 129626, Moscow, Grafsky lane, 4/9
2Central Research Institute of Epidemiology, Russia, 111123, Moscow, Novogireevskaya street, 3a
3I. M. Sechenov First Moscow State Medical University, Russia, 119435, Moscow, Bolshaya Pirogovskaya street, 2, building 4
Abstract
Introduction. Nosocomial infections are an urgent problem for the healthcare system, which necessitates regular microbiological monitoring in hospitals.
Aim of the study was to conduct microbiological monitoring of microorganisms in intensive care units for patients with new coronavirus infection.
Materials and methods. A total of 2,240 swabs were collected from environmental objects in intensive care units across 35 hospitals in Moscow.
Results. The circulation of microorganisms was established in 13 hospitals in Moscow (37.1%). The dominant microorganisms were coagulase-negative staphylococci. The largest number of positive flushes were obtained from artificial lung ventilation systems. The proportion of microorganisms with multidrug resistance was noted at 12.2%.
Conclusion. The epidemiological situation in the intensive care units of Moscow hospitals requires increased control over the epidemiological regime.
Keywords: intensive care units, microbiological monitoring, microorganisms, new coronavirus infection, flushes from facilities, staphylococci.
USE OF THREE-DIMENSIONAL PRINTING TECHNOLOGIES
IN THE COMPLEX TREATMENT OF MIDDLE FACE INJURIES
S.A. Peleshok, L.S. Tsygan, A.A. Kolbin, V.A. Virko, I.V. Klishin,
A.A. Vlasovets, M.S. Prokofev, A.A. Sukhorukov
S. M. Kirov Military Medical Academy, St. Petersburg, Russia, Academician Lebedev street 6
Abstract
Introduction. Three-dimensional printing (3D printing) and reconstructive surgery are two fields that, when combined, open up new treatment possibilities for conditions previously limited to traditional treatment methods. Reconstructive surgery, both elective and emergency, actively utilizes new 3D modeling and printing technology to minimize patient preparation time for surgery, improve the cosmetic outcome of interventions, and reduce the number of postoperative complications. The modern capabilities of 3D printing are expanding, with increasing quality and variety of software, 3D printers, and materials, biocompatible materials are being synthesized, suitable for use in 3D printing and subsequent implantation in order to replace the defect.
The aim of the study is to demonstrate the experience of using 3D modeling and printing techniques for preoperative planning and conducting elective and emergency reconstructive operations for middle face injuries.
Materials and methods. A search and analysis of domestic and foreign publications from 2016 to 2024 was performed. Based on the presented results of non-invasive (tomographic) studies of patients in DICOM format, a set of equipment was used, including a graphics station (a stationary personal computer with an Intel Core I7-6700 processor, an NVIDIA GeForce GTX 1060 6GB GPU and a 32 GB RAM block), software (COMPASS 3D, SolidWorks, CURA, Polygon X) and 3D printers (Ender 3 Pro and Picaso Designer X Pro S2) printing by modeling layered plastic deposition of polylactide and acrylonitrile butadiene styrene, 1.75 mm in cross-section diameter.
Results. The article presents clinical cases reflecting the experience of surgeons from the Military Medical Academy and specialists of the research Center in using three-dimensional modeling and 3D printing technologies for preoperative models in conjunction with surgical procedures for various complex pathologies of middle face injuries during 2023-2024.
Conclusion. The high efficiency of applying three-dimensional modeling and 3D printing technologies as an auxiliary element in the classical management of surgical patients during preoperative planning and surgical intervention has been confirmed.
Keywords: three-dimensional modeling; three-dimensional printing; surgery; clinical case; implant; biocompatibility; preoperative planning.
INFECTIOUS COMPLICATIONS IN PATIENTS RECEIVING HEMODIALYSIS
O.V. Dmitrieva, A.V. Liubimova, L.V. Belova
North-Western State Medical University named after I.I. Mechnikov, Russia, 191015, Saint Petersburg, Kirochnaya street, 41
Abstract
Introduction. Infectious complications in patients receiving renal replacement therapy pose a significant threat to their health and life. Invasive interventions, kidney disease and comorbidities, frequent hospitalisation contribute to the development of infections, including healthcare-associated infection.
The aim of the study is to identify the frequency, structure and etiology of infectious complications in patients receiving hemodialysis, both upon admission to departments of various profiles and during hospitalization.
Materials and Methods. Medical records of 855 patients receiving haemodialysis in 2020-2023, hospitalized in different departments of multidisciplinary clinics, were analyzed.
Results. A high frequency of hospitalizations for hemodialysis patients in various departments was identified. A total of 214 infections (25.02 per 100 patients, 25.32 per 100 hospitalizations) were detected in 104 patients: bloodstream infections -87 cases (10.17 per 100 patients), respiratory tract infections-45 cases (5.26 per 100 patients), urinary tract infections -33 cases (3.86 per 100 patients), surgical site infections-24 cases (1.58 per 100 patients), skin and soft tissue infections -16 cases (1.87 per 100 patients), infective endocarditis-8 cases (0.94 per 100 patients). More than one infection occurred in 62 (59.61%) patients, 65% of the infections occurred more than 48 hours after admission to the department. The etiology was identified in 72% of infections detected at admission and in 60% of healthcare-associated infections (HAIs). The etiological structure of the infections was diverse; however, Staphylococcus aureus was the most frequently isolated microorganism.
Conclusion. A high risk of infectious complications in hemodialysis patients has been revealed both at admission to various departments and during treatment. It is necessary to develop and implement epidemiological surveillance programs and microbiological monitoring of hemodialysis patients hospitalized in non-dialysis units.
Keywords: hemodialysis, renal replacement therapy, infectious complications, hospitalization, healthcare-associated infections.
PUBLIC HEALTH, ORGANIZATION AND SOCIOLOGY OF HEALTH CARE
THE ROLE OF INFECTIOUS FACTOR IN EARLY TERMINATION OF PREGNANCY: IMPORTANCE FOR ORGANIZING CARE FOR PREGNANT WOMEN
O.V. Tyumina1,2, O.M. Degeleva1,2, O.A. Khashina2
1Samara Regional Medical Center «Dynasty», Russia, 443095, Samara, Tashkentskaya street, 159
2Samara State Medical University, Russia, 443099, Samara, Chapaevskaya street, 89
Abstract
Introduction. Spontaneous abortion is one of the main types of obstetric pathology, with a frequency of 15-20% of all desired pregnancies. The causes of spontaneous abortions in in the early stages of pregnancy are extremely diverse and not always clearly defined.
Aim of the study was to analyze the impact of infectious factors on pregnancy outcomes in early and late stages and to develop a set of organizational measures for prevention and timely treatment to improve perinatal indicators.
Materials and methods. Microbiological examination of urine and cervical canal discharge was conducted in 215 women, average age 31±2.1 years, who were at risk of pregnancy termination at a gestational age of 15±3.0 weeks. The participants were divided into two groups: Group 1 (190 individuals) - pregnancy was saved, Group 2 (25 individuals) - pregnancy was terminated. Laboratory, sociological and statistical research methods were used.
Results. The analysis showed that positive bacteriological results from urine and cervical canal discharge do not have a statistically significant effect on the abortion outcomes in early stages of pregnancy. However, these data should be considered as a risk factor for pregnancy loss and preterm birth at later stages. The leading pathogens were E. coli and Enterococcus faecalis.
Conclusion. In order to reduce the incidence of infectious complications and improve perinatal outcomes, the authors propose a set of measures, including increasing awareness among the population and health workers, improving screening and diagnostic system, optimizing treatment and preventive measures, developing interdisciplinary interaction between specialists and research activities.
Key words: spontaneous abortion, bacteriuria, risk factors for pregnancy loss
ORGANIZATIONAL MODELS OF OUTPATIENT ADMISSION OF A DISTRICT GENERAL PRACTITIONER
O.V. Khodakova, T.G. Bogdanova, A.M. Shakhova
Russian Research Institute of Health, Russia, 127254, Moscow, Dobrolyubova street, 11
Abstract
Introduction. Ensuring accessibility in the primary healthcare system, as the basis of the health care system, remains relevant. The most demanded specialist for providing medical care to the adult population at the outpatient stage remains a district therapist. In the system of public healthcare system in the Russian Federation, there are organizational solutions aimed at freeing up the time of district therapists from a number of routine procedures and documentation processes to increase the time of direct contact with patients. Such solutions contribute to the rational use of human resources of medical organizations, allowing to increase the accessibility and quality of primary healthcare services without additional costs. A comparative analysis of throughput per hour and per working shift in organizing outpatient appointments for district therapists using such solutions has not been conducted.
The aim of the study is to develop organizational models for the work of a district general practitioner and a district nurses, that optimize patient interaction time and increase the throughput of outpatient appointments for district therapists.
Materials and methods. The study of the issues of providing primary health care to the adult population during outpatient appointment with district therapists was conducted based on content analysis including a review of normative-legal documents and the results of scientific research by domestic authors.
The study used materials from scientific electronic libraries eLibrary, «CyberLeninka», reference legal system «Consultant Plus», «Garant», the website of the Ministry of Health of Russia and publicly accessible internet resources, that met the inclusion criteria for analysis (compliance with the selected research topic, full-text format of the work, open (free) access). The search was conducted using the following keywords: primary health care, independent reception, delegation of functions, medical post, non-medical staff, throughput.
Based on the method of organizational modeling, solutions for the organization of outpatient reception of a district general practitioner have been developed: the minimum number of participants in the process to perform one cycle of work has been consistently determined; a calculation of the baseline time necessary for the reception of one patient by all participants in the process has been conducted; the list of functional duties for each employee has been assessed by the coefficient of labor intensity of functional duties. When the number of performed tasks changes, the coefficient of labor intensity of functional duties changes, affecting the time spent on the receiving one patient. To determine the effectiveness of a particular organizational model in terms of throughput, the normative throughput of outpatient appointments was calculated.
Results. Organizational models for outpatient reception by a district general practitioner were formed, based on structured decisions on redistribution of functions between separate categories of medical and non-medical personnel, as well as on formation of patient flows according to the purpose of their treatment. The throughput capacity of each of the models was determined, taking into account the labor intensity of functional duties and time spent on the receiving one patient. A comparative analysis of the throughput per hour and per working shift of the proposed organizational solutions for outpatient reception by a district general practitioner has been carried out.
Conclusion. The throughput capacity of the proposed organizational models of outpatient admission of a district general practitioner varies depending on the number of participants in the process and the labor functions assigned to them. Thus, the introduction of an independent reception of a nurse with a higher education in nursing (bachelor's degree) or a paramedic into the «classical model» of outpatient reception of a district general practitioner increases the throughput capacity of the model almost three times. The organization of a medical post with the withdrawal of district nurses from the joint reception with district physicians increases the throughput capacity by more than 35%, compared to the simultaneous work of the same number of specialists according to the principles of the «classical mode». The organization of independent reception of nurses with higher education in «Nursing» (bachelor's degree) or paramedics in parallel with outpatient reception of district therapists increases the throughput capacity of outpatient reception three times, compared to the simultaneous work of the same number of specialists within the «classical model».
Keywords: primary health care, independent reception, delegation of functions, medical post, non-medical staff, throughput capacity.
CLINICAL LABORATORY DIAGNOSTICS
PROBLEMS IN THE DIAGNOSIS OF FOOD INTOLERANCE, QUESTIONABLE SIGNIFICANCE OF DIAMINE OXIDASE, POSSIBILITY OF HISTAMINE INACTIVATION COEFFICIENT IN PATIENTS WITH CHRONIC URTICARIA
N.V. Mikryukova1, N.V. Bychkova1, N.M. Kalinina1,2
1Nikiforov Russian Center of Emergency and Radiation Medicine, EMERCOM of Russia, St. Petersburg, Russia
2St. Petersburg Pavlov State Medical University, Ministry of health of Russia
Abstract
Most food reactions require careful assessment and confirmation, as dietary restrictions could lead to negative consequences and a decline in quality of life. This article presents a review of the latest data on food intolerance and the results of the present research concerning the determination of histamine, diamine oxidase (DAO), and the histamine inactivation ratio in patients with chronic urticaria (CU).
The study included 165 adults aged 18 to 68 years; 97 patients suffering from chronic urticaria, while the comparison group consisted of 68 healthy individuals. The levels of histamine and diamine oxidase in the blood serum were assessed using the enzyme-linked immunosorbent assay (ELISA). The histamine inactivation coefficient was calculated as the ratio of histamine to diamine oxidase.
There was an increase in histamine concentration and histamine inactivation coefficient in patients with CU in relation to the comparison group - 23.92ng/ml and 10.93 ng/ml; 1.74 and 0.82, respectively. Patients with CU and food intolerance had a history of increased histamine concentration and histamine inactivation coefficient in relation to the group of patients without food intolerance and conditionally healthy individuals. Patients with concomitant digestive system pathology showed increased levels of diamine oxidase, which corresponds to diamine oxidase as a marker of mucosal integrity.
The study indicated the questionable significance in measuring diamine oxidase as an independent diagnostic parameter; however, it was found that the histamine inactivation ratio may serve as a new biomarker of food intolerance in patients with CU.
Key words: histamine, diamine oxidase, histamine inactivation coefficient, chronic urticaria.
CLINICAL AND IMMUNOLOGICAL INDICATORS OF THE HEALTH STATUS OF CHILDREN WITH GIARDIASIS
I.B. Ershova, O.V. Petrenko
Federal State Budgetary Educational Institution of Higher Education "Lugansk State Medical University named after St. Luke" of the Ministry of Health of the Russian Federation, 291045, Russian Federation, Lugansk People's Republic, urban district Lugansk, city of Lugansk, kv-l 50-letiya oborony Luganska, d. 1g
Abstract.
Introduction. Infection with giardiasis in children's groups reaches 50-80%. Despite the abundance of publications, the issue of differences in the course of giardiasis in children of different ages and the immune system`s response to Giardia invasion remains poorly studied.
The aim of the study is to analyze the clinical and immunological characteristics of children infected with Giardia, focusing on age-related differences.
Materials and methods. Children with giardiasis of two age subgroups were observed - I (median age 4.2 years) - 71 participants and II (median age 15.9 years) - 63 participants. The control group (n = 63) included children of the same age and sex. A set of indicators characterizing cellular and humoral immunity was studied.
Results and discussion. For children aged 1 to 12 years, the acute course of giardiasis is characterized by clinical manifestations such as decreased appetite, flatulence and intestinal rumbling, loose stools, headache, abdominal pain, allergic skin rashes, asthenonerotic symptoms. Children aged 13 to 18 years predominantly experienced a chronic course of giardiasis, with symptoms including abdominal pain of various localizations, decreased appetite, bloating and rumbling, frequent liquid foul-smelling stools, nausea, belching, increased fatigue, emotional lability, subfebrile condition, decreased mood, pale skin, tearfulness, depressed mood, vegetative manifestations, broncho-asthmatic manifestations. Immunological assessments reveal a decrease in
CD4 + and an increase in CD8 +, and a decrease in the immunoregulatory index. A decrease in CD4+ and an increase in CD8+ were noted. The IgA level was below the control values.
Conclusions. In response to Giardia invasion, children experience changes in both cellular and humoral immunity, indicating varying degrees of impairment in immunological reactivity and have unidirectional changes in children of primary, preschool-school and adolescent age.
Key words: giardiasis, children, immunity, giardia, parasitosis.